DOCSLIB.ORG

Unintentional Drug- and Alcohol-Related Intoxication Deaths* in Maryland

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Unintentional Drug- and Alcohol-Related Intoxication Deaths* in Maryland Unintentional Drug- and Alcohol-Related Intoxication Deaths* in Maryland Preliminary data update through 1st quarter 2019 This report contains counts of unintentional drug- and alcohol-related intoxication deaths* occurring in Maryland through the 1st quarter of 2019, the most recent period for which preliminary data are available. Counts are also shown for the same period of 2007-2018 to allow for review of trends over time. Counts for 2018 and 2019 are not complete and are subject to change. Since an intoxication death may involve more than one substance, counts of deaths related to specific substances do not sum to the total number of deaths. *Deaths resulting from recent ingestion or exposure to alcohol or other types of drugs, including heroin, prescription opioids, prescribed and illicit forms of fentanyl (including carfentanil), cocaine, benzodiazepines, phencyclidine (PCP), methamphetamines and other prescribed and unprescribed drugs. Figure 1. Total Number of Unintentional Intoxication Deaths Occurring in Maryland from January-March of Each Year.* 800 700 676 600 577 555 500 401 deaths 400 318 300 253 Number of 192 189 200 176 184 177 186 149 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 2 Figure 2. Number of Opioid-Related Deaths Occurring in Maryland from January through March of Each Year.* 700 601 600 515 500 482 deaths 400 350 300 270 Number of 226 200 157 132 132 136 145 145 108 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 3 Figure 3. Number of Heroin-Related Deaths Occurring in Maryland from January through March of Each Year.* 350 300 291 245 250 219 190 deaths 200 188 146 150 Number of 100 91 77 75 74 64 62 63 50 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 4 Figure 4. Number of Fentanyl-Related Deaths Occurring in Maryland from January through March of Each Year.* 600 517 500 474 400 371 deaths 300 Number of 200 157 100 73 39 6 6 5 12 12 11 8 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 5 Figure 5. Number of Carfentanil-Related Deaths Occurring in Maryland from January through March of Each Year.* 1 0.9 0.8 0.7 0.6 deaths 0.5 0.4 Number of 0.3 0.2 0.1 0 0 0 0 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019* counts are preliminary. ** Screening for Carfentanil began in 2016, first detected in Q3 2017 6 Figure 6. Number of Prescription Opioid-Related Deaths Occurring in Maryland from January through March of Each Year.* 120 104 106 100 99 100 93 87 89 83 82 80 76 73 70 deaths 60 53 Number of 40 20 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 7 Figure 7. Number of Cocaine-Related Deaths Occurring in Maryland from January through March of Each Year.* 250 Not in combination with opioids In combination with opioids 200 150 deaths 210 100 165 Number of 114 50 72 42 24 51 27 27 40 20 19 24 21 26 21 16 18 11 12 12 17 0 10 6 6 7 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 8 Figure 8. Number of Alcohol-Related Deaths Occurring in Maryland from January through March of Each Year.* 160 Alcohol alone Alcohol in combination with other substances 140 120 100 deaths 80 114 110 101 Number of 60 84 40 57 39 30 43 56 42 32 30 20 19 25 16 21 16 21 17 13 11 12 11 14 9 11 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018* 2019* *2018, 2019 counts are preliminary. 9 Table 1. Comparison of Total Drug and Alcohol-Related Intoxication Deaths1,2 by Place of Occurrence, Maryland, January -- March, 20193 and 2018. Jurisdiction Drug & Alcohol Intoxication Deaths 2019 vs 2018 Jan. - Mar. 2019 Jan. - Mar. 2018 # DIFFERENCE Maryland Total 577 676 -99 Allegany 8 9 -1 Anne Arundel 50 71 -21 Baltimore City 243 248 -5 Baltimore County 78 116 -38 Calvert 11 3 8 Caroline 4 0 4 Carroll 13 28 -15 Cecil 12 19 -7 Charles 3 5 -2 Dorchester 0 2 -2 Frederick 21 25 -4 Garrett 1 2 -1 Harford 20 30 -10 Howard 10 11 -1 Kent 3 0 3 Montgomery 25 25 0 Prince George's 21 30 -9 Queen Anne's 4 3 1 Somerset 0 3 -3 St. Mary's 4 5 -1 Talbot 2 2 0 Washington 26 19 7 Wicomico 9 11 -2 Worcester 9 9 0 1Includes deaths that were the result of recent ingestion or exposure to alcohol or another type of drug, including heroin, cocaine, prescription opioids, benzodiazepines, and other prescribed and unprescribed drugs. 2Includes only deaths for which the manner of death was classified as accidental or undetermined. 3Counts for 2018, 2019 are not complete. 10 Table 2. Comparison of Opioid-Related Intoxication Deaths1,2 by Place of Occurrence, Maryland, January -- March, 20193 and 2018. Jurisdiction Opioid Intoxication Deaths 2019 vs 2018 Jan. - Mar. 2019 Jan. - Mar. 2018 # DIFFERENCE Maryland Total 515 601 -86 Allegany 7 7 0 Anne Arundel 45 68 -23 Baltimore City 224 225 -1 Baltimore County 72 103 -31 Calvert 8 1 7 Caroline 4 0 4 Carroll 13 27 -14 Cecil 10 19 -9 Charles 3 4 -1 Dorchester 0 1 -1 Frederick 20 23 -3 Garrett 0 2 -2 Harford 18 28 -10 Howard 8 10 -2 Kent 3 0 3 Montgomery 19 20 -1 Prince George's 14 20 -6 Queen Anne's 4 3 1 Somerset 0 3 -3 St. Mary's 4 5 -1 Talbot 2 2 0 Washington 23 16 7 Wicomico 7 9 -2 Worcester 7 5 2 1Includes deaths that were the result of recent ingestion or exposure to any opioid, prescribed or illicit. 2Includes only deaths for which the manner of death was classified as accidental or undetermined. 3Counts for 2018, 2019 are not complete. 11 Table 3. Comparison of Heroin-Related Intoxication Deaths1,2 by Place of Occurrence, Maryland, January -- March, 20193 and 2018. Jurisdiction Heroin Intoxication Deaths 2019 vs 2018 Jan. - Mar. 2019 Jan. - Mar. 2018 # DIFFERENCE Maryland Total 188 245 -57 Allegany 1 2 -1 Anne Arundel 11 24 -13 Baltimore City 85 84 1 Baltimore County 32 38 -6 Calvert 5 1 4 Caroline 1 0 1 Carroll 4 15 -11 Cecil 3 12 -9 Charles 2 2 0 Dorchester 0 1 -1 Frederick 8 10 -2 Garrett 0 1 -1 Harford 7 10 -3 Howard 2 2 0 Kent 0 0 0 Montgomery 9 11 -2 Prince George's 7 6 1 Queen Anne's 1 1 0 Somerset 0 3 -3 St. Mary's 1 2 -1 Talbot 0 2 -2 Washington 5 10 -5 Wicomico 2 4 -2 Worcester 2 4 -2 1Includes deaths that were the result of recent ingestion or exposure to heroin. 2Includes only deaths for which the manner of death was classified as accidental or undetermined. 3Counts for 2018, 2019 are not complete. 12 Table 4. Comparison of Fentanyl-Related Intoxication Deaths1,2 by Place of Occurrence, Maryland, January -- March, 20193 and 2018. Jurisdiction Fentanyl Intoxication Deaths 2019 vs 2018 Jan. - Mar. 2019 Jan. - Mar. 2018 # DIFFERENCE Maryland Total 474 517 -43 Allegany 6 5 1 Anne Arundel 40 56 -16 Baltimore City 215 211 4 Baltimore County 62 87 -25 Calvert 8 0 8 Caroline 3 0 3 Carroll 12 20 -8 Cecil 10 14 -4 Charles 3 3 0 Dorchester 0 0 0 Frederick 19 22 -3 Garrett 0 1 -1 Harford 15 24 -9 Howard 6 9 -3 Kent 3 0 3 Montgomery 17 13 4 Prince George's 14 16 -2 Queen Anne's 3 3 0 Somerset 0 3 -3 St. Mary's 3 4 -1 Talbot 2 2 0 Washington 20 12 8 Wicomico 6 7 -1 Worcester 7 5 2 1Includes deaths that were the result of recent ingestion or exposure to fentanyl. 2Includes only deaths for which the manner of death was classified as accidental or undetermined. 3Counts for 2018, 2019 are not complete. 13 Table 5. Total Number of Drug and Alcohol-Related Intoxication Deaths1,2 by Place of Occurrence, Maryland, 2007-2018 and YTD 2019 Through March.3 Jurisdiction Drug & Alcohol Intoxication Deaths 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 YTD Maryland Total 815 694 731 649 671 799 858 1,041 1,259 2,089 2,282 2,420 577 Allegany 14 9 9 15 12 14 15 12 22 59 38 39 8 Anne Arundel 71 70 63 56 79 83 78 101 112 195 214 243 50 Baltimore City 287 184 239 172 167 225 246 305 393 694 761 892 243 Baltimore County 131 118 106 115 107 119 144 170 220 336 367 391 78 Calvert 14 9 14 6 12 12 6 17 20 28 32 28 11 Caroline 1 4 2 2 11 4 2 7 3 10 11 7 4 Carroll 14 17 22 15 8 29 24 38 40 47 55 72 13 Cecil 25 10 24 24 28 25 26 29 32 30 59 60 12 Charles 13 16 11 13 11 13 9 21 22 45 37 27 3 Dorchester 4 5 2 6 2 5 5 0 1 6 12 7 0 Frederick 23 15 23 20 30 26 37 42 40 88 78 78 21 Garrett 1 3 3 3 2 0 6 2 5 1 8 3 1 Harford 31 35 33 43 38 39 36 43 50 84 101 101 20 Howard 16 19 16 10 21 24 29 21 26 46 51 42 10 Kent 3 4 2 5 2 0 4 6 3 6 5 2 3 Montgomery 56 46 44 38 44 48 52 65 70 102 116 91 25 Prince George's 53 58 59 43 42 56 59 63 70 129 167 127 21 Queen Anne's 4 5 4 4 5 2 8 10 4 8 8 17 4 Somerset 6 3 4 1 3 3 4 3 6 8 4 8 0 St.
Load more

Recommended publications
  • Cocaine Use Disorder
    COCAINE USE DISORDER ABSTRACT Cocaine addiction is a serious public health problem. Millions of Americans regularly use cocaine, and some develop a substance use disorder. Cocaine is generally not ingested, but toxicity and death from gastrointestinal absorption has been known to occur. Medications that have been used as substitution therapy for the treatment of a cocaine use disorder include amphetamine, bupropion, methylphenidate, and modafinil. While pharmacological interventions can be effective, a recent review of pharmacological therapy for cocaine use indicates that psycho-social efforts are more consistent over medication as a treatment option. Introduction Cocaine is an illicit, addictive drug that is widely used. Cocaine addiction is a serious public health problem that burdens the healthcare system and that can be destructive to individual lives. It is impossible to know with certainty the extent of use but data from public health surveys, morbidity and mortality reports, and healthcare facilities show that there are millions of Americans who regularly take cocaine. Cocaine intoxication is a common cause for emergency room visits, and it is one drug that is most often involved in fatal overdoses. Some cocaine users take the drug occasionally and sporadically but as with every illicit drug there is a percentage of people who develop a substance use disorder. Treatment of a cocaine use disorder involves psycho-social interventions, pharmacotherapy, or a combination of the two. 1 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com Pharmacology of Cocaine Cocaine is an alkaloid derived from the Erthroxylum coca plant, a plant that is indigenous to South America and several other parts of the world, and is cultivated elsewhere.
    [Show full text]
  • Cocaine Intoxication and Hypertension
    THE EMCREG-INTERNATIONAL CONSENSUS PANEL RECOMMENDATIONS Cocaine Intoxication and Hypertension Judd E. Hollander, MD From the Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. 0196-0644/$-see front matter Copyright © 2008 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2007.11.008 [Ann Emerg Med. 2008;51:S18-S20.] with cocaine intoxication is analogous to that of the patient with hypertension: the treatment should be geared toward the Cocaine toxicity has been reported in virtually all organ patient’s presenting complaint. systems. Many of the adverse effects of cocaine are similar to When the medical history is clear and symptoms are mild, adverse events that can result from either acute hypertensive laboratory evaluation is usually unnecessary. In contrast, if the crisis or chronic effects of hypertension. Recognizing when the patient has severe toxicity, evaluation should be geared toward specific disease requires treatment separate from cocaine toxicity the presenting complaint. Laboratory evaluation may include a is paramount to the treatment of patients with cocaine CBC count; determination of electrolyte, glucose, blood urea intoxication. nitrogen, creatine kinase, and creatinine levels; arterial blood The initial physiologic effect of cocaine on the cardiovascular gas analysis; urinalysis; and cardiac marker determinations. system is a transient bradycardia as a result of stimulation of the Increased creatine kinase level occurs with rhabdomyolysis. vagal nuclei. Tachycardia typically ensues, predominantly from Cardiac markers are increased in myocardial infarction. Cardiac increased central sympathetic stimulation. Cocaine has a troponin I is preferred to identify acute myocardial13 infarction. cardiostimulatory effect through sensitization to epinephrine A chest radiograph should be obtained in patients with and norepinephrine.
    [Show full text]
  • Why Does Smoking So Often Produce Dependence? a Somewhat Diverent View
    62 Tobacco Control 2001;10:62–64 Tob Control: first published as 10.1136/tc.10.1.62 on 1 March 2001. Downloaded from COMMENTARY Why does smoking so often produce dependence? A somewhat diVerent view John R Hughes Abstract These explanations often give little emphasis The usual explanation for why smoking to the possibility that nicotine induces depend- produces dependence focuses on the ence because it produces beneficial eVects that eVects of nicotine on dopamine and other can help smokers cope with their environ- neurobiological explanations. This review ment.89 By beneficial eVects, I mean positive oVers four somewhat diVerent explana- eVects that are not due to relief of withdrawal tions: (1) nicotine can oVer several but rather are eVects above and beyond a “nor- psychopharmacological benefits at the age mal” baseline functioning.10 when such benefits are especially needed; Whether nicotine via smoking causes true (2) cigarettes provide for a rapid, beneficial eVects is, to many, debatable.891112 frequent, reliable and easy-to-obtain My belief (and that of others before me89) that reward; (3) nicotine is not intoxicating, nicotine can cause true beneficial eVects is allowing chronic intake; and (4) the long based on three sets of data. First, nicotine often duration of the nicotine withdrawal causes improvements in animals with no syndrome eVectively undermines cessa- history of nicotine exposure, in never smokers, tion. This article reviews the evidence for and in non-deprived smokers.8911 Second, the above views and the tobacco control most other drugs of dependence produce ben- activities these views suggest. eficial eVects—for example, cocaine produces (Tobacco Control 2001;10:62–64) stimulation and alcohol produces relaxation http://tobaccocontrol.bmj.com/ Keywords: nicotine; substance use disorder; substance and increased confidence.
    [Show full text]
  • Treatment of Patients with Substance Use Disorders Second Edition
    PRACTICE GUIDELINE FOR THE Treatment of Patients With Substance Use Disorders Second Edition WORK GROUP ON SUBSTANCE USE DISORDERS Herbert D. Kleber, M.D., Chair Roger D. Weiss, M.D., Vice-Chair Raymond F. Anton Jr., M.D. To n y P. G e o r ge , M .D . Shelly F. Greenfield, M.D., M.P.H. Thomas R. Kosten, M.D. Charles P. O’Brien, M.D., Ph.D. Bruce J. Rounsaville, M.D. Eric C. Strain, M.D. Douglas M. Ziedonis, M.D. Grace Hennessy, M.D. (Consultant) Hilary Smith Connery, M.D., Ph.D. (Consultant) This practice guideline was approved in December 2005 and published in August 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available in the Psychiatric Practice section of the APA web site at www.psych.org. 1 Copyright 2010, American Psychiatric Association. APA makes this practice guideline freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this guideline may be reproduced except as permitted under Sections 107 and 108 of U.S. Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at http://www.appi.org/CustomerService/Pages/Permissions.aspx. AMERICAN PSYCHIATRIC ASSOCIATION STEERING COMMITTEE ON PRACTICE GUIDELINES John S. McIntyre, M.D., Chair Sara C. Charles, M.D., Vice-Chair Daniel J. Anzia, M.D. Ian A. Cook, M.D. Molly T. Finnerty, M.D. Bradley R. Johnson, M.D. James E. Nininger, M.D. Paul Summergrad, M.D. Sherwyn M.
    [Show full text]
  • Drugs of Abuse 2 Ceus By: Louis Durkin, MD
    Drugs of Abuse 2 CEUs By: Louis Durkin, MD INTRODUCTION An overview of the epidemiology, demographics, and pharmacology of the most common drugs of abuse. It covers the likely complications and side effects of the drugs, as well as potential interaction with other drugs. You will also learn about the most recent trends in abuse, such as "rave" and date rape drugs. Objectives By the end of this lecture, the participant should be able to... 1. Describe the new drugs of abuse 2. Explain "rave" drugs 3. Explain date rape drugs 4. List the pharmacology of the common drugs of abuse 5. List the clinical signs and symptoms of drugs of abuse 6. Explain the most likely life-threatening presentations of drugs of abuse 7. Explain treatment, including specific antidotes for patients taking these drugs 8. Describe intoxication and withdrawal symptoms and their treatment Introduction • Drug abuse is a common problem in the US. • There are many common drugs of abuse, each with it's own mechanism of action and potential unwanted side effects. • Most of the traditional drugs of abuse are still widespread among the youth of this country, with many newer versions on the rise. • Many of the familiar drugs such as marijuana, amphetamines, heroin and alcohol have leveled off in usage over the past few years with a recent surge of the newer "rave" and date rape drugs. Some, such as ecstasy, are just new versions of an old drug, where others, such as GHB are in a class unto themselves. • This lecture will cover the pharmacology of the most common agents, and focus on recognition and treatment of the various agents.
    [Show full text]
  • A Guide to Substance Abuse Services for Primary Care Clinicians
    Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment A Guide to Substance Abuse Services for Primary Care Clinicians Treatment Improvement Protocol (TIP) Series 24 A Guide to Substance Abuse Services for Primary Care Clinicians Treatment Improvement Protocol (TIP) Series 24 Eleanor Sullivan, Ph.D., R.N., F.A.A.N. Michael Fleming, M.D., M.P.H. Consensus Panel Co-Chairs U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 This publication is part of the Substance Abuse I.C.A.D.C., served as the CSAT government Prevention and Treatment Block Grant technical project officer. Paddy Cook, Constance Grant assistance program. All material appearing in Gartner, M.S.W., Lise Markl, Randi Henderson, this volume except that taken directly from Margaret K. Brooks, Esq., Donald Wesson, M.D., copyrighted sources is in the public domain and Mary Lou Dogoloff, Virginia Vitzthum, and may be reproduced or copied without Elizabeth Hayes served as writers. Special permission from the Substance Abuse and thanks to Daniel Vinson, M.D., M.S.H.P., Mim J. Mental Health Services Administration’s Landry, Mary Smolenski, C.R.N.P., Ed.D., (SAMHSA) Center for Substance Abuse MaryLou Leonard, Pamela Nicholson, Annie Treatment (CSAT) or the authors. Citation of Thornton, Jack Rhode, Cecil Gross, Niyati the source is appreciated. Do not reproduce or Pandya, and Wendy Carter for their distribute this publication for a fee without considerable contributions to this document.
    [Show full text]
  • CLINICAL PRESENTATIONS: NEUROLOGY Withdrawal with Delirium, Convulsions and Hallucinations and 16% of Patients and the Onset of the Syndrome May Be Acute, Delusions
    CATEGORY I – CLINICAL PRESENTATIONS: NEUROLOGY 1.0 Introduction The overlap between neurological and substance use disorders is significant. About one in five of neurology patients have a lifetime history of a substance use disorder with 13% reporting a current episode. In addition to overdose, withdrawal, and addictive behaviour, licit and illicit drugs produce a wide range of neurologic complications, therefore detection and treatment are essential. Substance misuse use can also lead to problems with memory, attention and decision-making as well as resulting in medical emergencies, seizures, acute confusional states and cognitive deterioration. S LEARNING OUTCOMES l Concomitant intoxication with different substances may confuse the clinical picture. T Medical students will gain knowledge in: 2.2 Barriers to access E 1. Describing the range of neurological symptoms associated with substance use disorders. l Neurological symptoms either not recognised or E ignored by patient. 2. Identifying signs and symptoms of neurological disorders affected by substance use. l Lack of skills in taking a history and ascertaining H substance use. 3. Describing an appropriate care plan. l S Patient may not disclose substance use because the relevance to the neurological problem may not be Vignette obvious. T Lianne is 26 and started using methamphetamine eight 2.3 Effects of substances on the nervous system C months ago, to which she was introduced by her (Intoxication and withdrawal) boyfriend. She suffered a cerebrovascular accident (CVA) Excessive or protracted substance misuse can lead to a A and following tests and investigations, it was diagnosed number of problems due to neurotoxicity. Some of the that her use of methamphetamine was one of the F social problems associated, such as violence and loss of primary causes of the high blood pressure that caused a control over the drug, may be directly related to the blood vessel in her brain to rupture.
    [Show full text]
  • Passive Inhalation of Cocaine by Infants
    Henry Ford Hospital Medical Journal Volume 38 Number 4 Article 14 12-1990 Passive Inhalation of Cocaine by Infants Sabrina M. Heidemann Mark G. Goetting Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Heidemann, Sabrina M. and Goetting, Mark G. (1990) "Passive Inhalation of Cocaine by Infants," Henry Ford Hospital Medical Journal : Vol. 38 : No. 4 , 252-254. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol38/iss4/14 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Original Contributions and Case Studies Passive Inhalation of Cocaine by Infants Sabrina M. Heidemann, MD,* and Mark G. Goetting, MD^ Cocaine abuse has increased gready in recent years, creating important medical, legal, and social problems. Urine drug testing is used to diagnose cocaine ingestion. The presence of the cocaine metabolite benzoylecgonlne (BZ) is commonly believed to be proof of recent cocaine intoxication. However, oral ingestion of even a minute quantity of cocaine can resull in a positive test resuh. BZ was delected in the urine of four nonbreast-fed infants aged 6 weeks to 14 months who were admitted with diagnoses unrelated to cocaine poisoning. These infants were exposed to cocaine hy passive inhalation of vapors generated by adult caretakers smoking "crack" cocaine. Two ofthe infants were retested 12 hours later and had no detectable BZ, strongly suggesting ingestion of a subpharmacologic amounl of cocaine.
    [Show full text]
  • DRUG INTOXICATION and WITHDRAWAL SYMPTOMS From: American Psychiatric Association
    DRUG INTOXICATION AND WITHDRAWAL SYMPTOMS From: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. George S. Braucht, LPC & CPCS; brauchtworks.com INTOXICATION WITHDRAWAL Depressants: Alcohol, Sedative, Hypnotic or Anxiolytics Behavioral-Psychological changes: Within several hours (4-12) or several days of reducing/stopping: 1) inappropriate sexual or aggressive behavior 1) autonomic hyperactivity (sweating or pulse rate >100) 2) mood liability or impaired judgment 2) increased hand tremor Physiological changes: 3) insomnia 1) slurred speech 4) nausea or vomiting 2) incoordination 5) transient visual, tactile or auditory hallucinations or 3) unsteady gait illusions 4) nystagmus (involuntary side-to-side 6) psychomotor agitation eye movement) 7) anxiety 5) attention or memory impairment 8) grand mal seizures Stimulants: Amphetamine, methamphetamine, cocaine, etc. Behavioral-Psychological changes: Within a few hours to several days dysphoric mood plus two 1) euphoria with enhanced vigor, gregariousness of the following: 2) hyperactivity, restlessness, or hypervigilance 1) fatigue 3) interpersonal sensitivity and talkativeness 2) vivid, unpleasant dreams 4) anxiety, tension, alertness, or grandiosity 3) insomnia or hypersomnia 5) repetitive behavior, anger, or fighting 4) increased appetite 6) affective blunting with fatigue, or sadness 5) psychomotor retardation or agitation and social withdrawal A “crash” typically follows and episode of intense, high-dose Physiological changes: using:
    [Show full text]
  • Cocaine and the Heart M Egred, G K Davis
    568 Postgrad Med J: first published as 10.1136/pgmj.2004.028571 on 2 September 2005. Downloaded from REVIEW Cocaine and the heart M Egred, G K Davis ............................................................................................................................... Postgrad Med J 2005;81:568–571. doi: 10.1136/pgmj.2004.028571 Cocaine is the second commonest illicit drug used and the N Genitourinary and obstetric: renal and testi- cular infarction, abruptio placentae, sponta- most frequent cause of drug related deaths. Its use is neous abortion, prematurity, and growth associated with both acute and chronic complications that retardation.9 may involve any system, the most common being the N Neurological: seizures, migraine, cerebral 10 cardiovascular system. Cocaine misuse has a major effect infarction, and intracranial haemorrhage. N Musculoskeletal and dermatological: rhabdo- in young adult drug users with resulting loss of productivity myolysis, skin ischaemia, superficial and deep and undue morbidity with cocaine related cardiac and venous thrombosis, and thrombophlebitis.11 cerebrovascular effects. Many cocaine users have little or In this review we will focus on the cardiovas- no idea of the risks associated with its use. Patients, health cular effects of cocaine. care professionals, and the public should be educated about the dangers and the considerable risks of cocaine PHARMACOLOGY OF COCAINE use. This review concentrates on the cardiovascular effects Cocaine (benzoylmethylecgonine, C17,H21,NO4) is an alkaloid extract from the leaf of the of cocaine and their management. Erythroxylon coca plant, which usually grows in ........................................................................... South America. It is available in two forms: N Hydrochloride salt: prepared by dissolving the alkaloid in hydrochloric acid forming a water ocaine is the second commonest illicit drug soluble powder or granule that decomposes used and the most frequent cause of drug when heated.
    [Show full text]
  • Cocaine Abuse and Addiction
    CLINICAL REVIEW Cocaine Abuse and Addiction Frank H. Gawin, MD New Haven, Connecticut The National Institute on Drug Abuse now considers cocaine the “ drug of greatest national public health concern." Lower prices and a new administration route, co­ caine smoking, have increased the potential for addiction. An estimated 2 million individuals in the United States may be addicted to cocaine, or four times the number addicted to heroin. Contrary to population representations of the intracta­ ble power of cocaine addiction, cocaine dependence is a treatable disorder. The primary care physician must become familiar with signs of dependence and with therapeutic approaches to cocaine abuse, with particular attention to emerging advances in both psychotherapy and pharmacotherapy. he National Institute on Drug Abuse has called co­ centers in the United States, leading to unprecedented T caine “the drug of greatest national public health con­ cocaine abuse and treatment-seeking in these urban areas. cern,” estimating there are 2 million addicts1—four times An estimated 95% of the 20 to 30 million individuals the number of heroin addicts. A new mode of using the who have used cocaine have thus far avoided dependence,1 drug, specifically smoking “cocaine base,” has proven to promoting the illusion that cocaine can be used safely. Two be as addictive as intravenous injection,2,3 generating un­ to 4 years usually pass from an initial intranasal exposure precedented popular concern about cocaine. to cocaine, followed by decreasing control of use, to ulti­ Cocaine has previously been sold as a water-soluble hy­ mate cocaine dependence.4 Other than in acute toxic over­ drochloride salt for intranasal (snorting) or intravenous dose, early adverse effects are seldom presented to physi­ (shooting) use.
    [Show full text]
  • Interpretation and Death Certificate
    Interpretation and Death Certificate Peter J. Koin PhD., D-ABFT CDC Foundation July 17, 2019 Learning Objectives • Become familiar with the OSAC/NAME recommendations and guidelines • Know how to report the toxicology results and autopsy findings • Know the case definitions for drug-caused death, drug poisoning death, drug-detected death, and drug Medicolegal Death Investigation Subcommittee Recommendations • Complete autopsy is necessary for optimal interpretation of toxicology results, which must also be considered in the context of the circumstances surrounding death, medical history, and scene findings • A complete scene investigation extends to reconciliation of prescription information and pill counts • Blood, urine, and vitreous humor when available, should be retained in all cases • A toxicological panel should be comprehensive and include opioid and benzodiazepines, as well as other potent depressant, stimulant, and anti-depressant medications • Interpretation of postmortem opioid concentrations requires correlation with medical history, scene investigation, and autopsy findings • If death is attributed to any drug or combination of drugs, the certifier should list all the responsible substances by generic name in the autopsy report and on the death certificate Toxicology Interpretation • Data interpretation of toxicology report must be taken with careful and critical consideration of other information 4 False Assumptions for Toxicology Interpretation • Postmortem blood drug concentrations reflect those at the moment of death •
    [Show full text]